Prevalence and associated factors of prolonged emergency department length of stay among adults patients attending University Hospital, South Ethiopia: a cross-sectional study

Prolonged length of stay in the emergency department is closely associated with hospital occupancy, contributes to increased healthcare costs, and may compromise patient safety. Extended stays have also been linked to adverse outcomes, including longer inpatient hospitalizations, higher treatment expenses, and increased risk of mortality. Evidence on the prevalence and determinants of such events in Ethiopia remains limited. To assess the prevalence and factors associated with prolonged Emergency Department Length of Stay among adult patients at Wolaita Sodo University Comprehensive and Specialized Hospital, 2025. An institution-based cross-sectional study was conducted from May 9 to June 18, 2025, including 401 adult patients selected through systematic random sampling. Data were collected using structured interviewer-administered questionnaires and observation checklists. Binary logistic regression identified factors associated with prolonged stay, with significance set at p < 0.05 in the multivariate analysis. Prolonged length of Emergency Department stay occurred in 56.1 % of patients. Independent predictors included altered mental status (AOR = 0.399; 95 % CI: 0.22–0.72), undergoing at least one laboratory investigation (AOR = 5.29; 95 % CI: 1.665–16.8), nurse shift changes during stay (AOR = 2.043; 95 % CI: 1.221–3.419), yellow triage category (AOR = 0.421; 95 % CI: 0.216–0.821), prior treatment before Emergency department arrival (AOR = 2.837; 95 % CI: 1.626–4.949), and lower educational attainment (AOR = 1.94; 95 % CI: 1.002–3.758). More than half of adult Emergency department patients experienced prolonged stays. System and patient-related factors such as, laboratory delays, shift handovers, triage processes, and health literacy influenced length of stay. Interventions to improve laboratory turnaround, standardize handovers, optimize triage, and enhance patient communication may reduce overcrowding and improve outcomes in resource-limited settings.